sherdk 2,540 Views
Joined: May 9, '12;
Posts: 21 (71% Liked)
; Likes: 47
I have to reply to this post, since I do feel strongly. I guess I am one of the "paranoid" ones, but I feel like it is my duty to protect myself.
I work in a Level I trauma center at a county hospital in a very large city that has very high crime rates that are only rising. We get psychs, custody patients from the prison and jail, and just down right crazies, including family members. When putting people in 4-point leather restraints and spit masks, and having to call security for people running around our campus with a knife becomes a daily basis thing, i feel I have the right to protect myself. And if that means my last name is covered up, and my badge is flipped around, then so be it. When I enter a patient's room, I will always introduce myself, and always state my purpose for being in the room. But as a human being, I too have worries about the people around me, and whats lurking in the parking lot when I return to my car after my shift has ended in the dark. I am also not the only one that feels this way in our department. The majority of employees will agree with me, especially the ones that have been threatened with death threats to themselves, or their family members. Yes, not all patients are capable of actually following through on these threats, but it only takes one. Call me crazy, but I think being "paranoid" is a good thing in my setting!
I think last names should not be on the badge but especially in cetain areas like the Emergency Department. Police can give their last names becasue they carry guns.
There are exceptions to everything. When I worked at the jail, I covered my last name with a little bit of masking tape. There is no inherent "right" for a pt to know a nurse's last name.
She knew what she wanted.
She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.
So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.
"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."
Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.
"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."
The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.
"I wish to die a peaceful, natural death."
She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.
"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."
Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.
"I wish nature to take its course, with only medication to prevent pain and suffering."
The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."
"Allow me the dignity we give to beloved pets. Let me die in peace."
I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.
Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.
"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."
She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.
And so was mine.
Sadly, that scenario plays itself out where I work with distressing regularity, but on children whose wishes are never sought out (and some not-really-children-anymore whose wishes ARE clear, but ignored) and whose quality of life is the last consideration on the list. Thank you for so eloquently expressing what so many of us feel.
Check everything you possibly can, head to toe assessment (at least neuro and heart/lungs) and MONITOR! You know that "sense of impending doom" they tell us about in nursing school? Yeah, that's real.
This happens a lot in peds where the parents say something isn't right with the child but can't quite put a finger on it. LISTEN TO THEM! Watch them, notify the doc, in peds we heavily rely on the parents when they say something isn't right. It might be just as simple as them not being interested in a favorite TV show, not wanting to eat, breathing slightly faster (but still WNL), etc. Last time I had a parent who told me kiddo didnt look right the kiddo arrested 30 minutes later. And he spent most of the morning sitting up in bed, watching Mickey and telling me about him. I personally thought it looked a little tired, like any child would be in the intensive care unit days after a major surgery, and his parents couldn't quite point out what was wrong except that something was wrong (it was his heart failing, by the way). Even if it's something that seems silly it doesn't hurt to listen to them and pay them a little more attenction
Listen to them and watch them like a hawk! And if they tell you 'now it's time to call son in Boston', RUN, do not walk to make the call to Boston.
the DON and some of the other "PTB" would start trying to get initials done. My charge nurse got really ugky one night, they were expecting a state inspection any day, and she told me that before I left my shift the next am, all the spots without initials needed to "be there" or else.
This is why it's SO important to convey to everyone you know, friends, family, and YOURSELF, to have a health care proxy, living revocable trust, just something legally in writing letting healthcare facilities know your wishes regarding your healthcare in the event you cannot express them yourself at the time. If more people took care of this on their own, we wouldn't have to worry or see it on the scale that we do.
I agree with JMBnurse. I think sometimes family members need "permission" to let go. I think that for some, there is a tremendous amount of guilt that comes with thinking you didn't do everything possible for your loved one, and they just need to know that they have, and that it's okay to let go.
I wear my hair in a ponytail, my scrubs are neatly pressed, but I like wearing makeup. Some would say my choice in make up is too heavy, as I like fake eyelashes d/t the fact that my own are so small and essentially invisible. I wear lip gloss, eyeshadow, etc.
I believe that putting forward a nice, neat, as well as professional appearance, includes a variety of more than acceptable "looks".
I worked in LTC for 6 years. This is familiar and touching. You have a beautiful way with words.
I have been an RN for 41 years and if a nurse tells you they have never made a mistake, they are lying to you! Learn from this, have a good cry and move on! Thank God he was OK. I had an experienced RN once leave an infiltrated IV running overnight in a baby's arm. When I came on shift I heard a baby crying in pain. I know that cry and I mentioned it to the nurse. She said, "he has been crying all night and he is a brat." He was 5 months old. I ran in there after report and took one look at that big arm, ripped the tape off, and the crying stopped. See, you made a mistake, and that is expected. You were not, what I call, "willfully ignorant." There is a huge difference and you are going to be OK.
Every last one of us has made a mistake and been extremely upset by it. You did everything else by the book, you had a doctor look at the patient, you filed an incident report. The fact that you feel bad shows your true potential of being a good nurse, not that you made a mistake. I bet you won't forget the tourniquet again! We are human, and have stressful busy jobs. Try not to be so hard on yourself, and good luck.
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